RESUMO
Nasal deformity in unilateral cleft lip and palate patients increases with time, tongue malposition being one of the causes. Some authors have emphasized the role of nasal and adjacent facial musculature as active extrinsic agents. Another cause of alar deformity can be the lack of a proper foundation because of a maxillary hypoplasia in the region of the pyriform foramen. If alar collapse occurs, the septum bends convexly toward the cleft side. Tissues are soft and plastic during the neonatal period. Once the infant is about 3 months of age, it becomes difficult to correct the nasal deformity. Therefore, any resource used from the first day, and mainly during the first 15 days of life, will be useful to prevent the increasing deformity and to avoid the surgical correction. A controlled clinical trial was planned to compare the anthropometric measurements of the nasal region in two series of patients with unilateral complete cleft lip. In the first group, we included 44 patients who came to our clinic during the first 2 days of life and the second group consisted of 47 patients who were more than 15 days of age at the time of the first consultation. To provide control data for the evaluation of the results after 6 years of follow-up in both series of cleft patients, we also included a third group of 48 healthy 6-year-old children. A nasal component added to the occlusal prostheses was only used in the first group up to the time of surgery. The same surgeon performed a Millard II procedure with muscular reposition as described by Delaire in all the patients. Nasal measurements taken with a caliper, obtained directly from plaster models by using surface impressions of the babies, were confirmed by a laser three-dimensional measuring device. The statistical comparison between both series showed a significant increase of the columellar length in the first group. A 6-year follow-up to compare growth and cosmetic results of the nose revealed a better and permanent nasal nostril symmetry and no alar cartilage luxation in the patients who had had the nasal component. These results highlight the importance of the early treatment and allow us to suggest the nasal prostheses as a way to prevent the increasing nasal deformity, to help nasal remodeling, to obtain columellar elongation, and to avoid or decrease the need for primary surgery of the cleft nose.
Assuntos
Fenda Labial/cirurgia , Nariz/anormalidades , Contenções , Antropometria , Criança , Fissura Palatina/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Nariz/crescimento & desenvolvimento , Nariz/patologiaRESUMO
El propósito del presente estudio fue evaluar los beneficios y las complicaciones que pudieran resultar de la reparación quirúrgica neonatal del labio y la nariz en pacientes portadores de fisura labio-alvéolo-palatina (FLAP) aislada. Con este fin, ingresaron a nuestro protocolo 22 recién nacidos con diferentes tipos de FLAP, los que fueron intervenidos con la técnica de Millard duranteel período Diciembre/93-Diciembre/94. Los neonatos toleraron perfectamente el procedimiento quirúrgico. Las pérdidas sanguíneas registradas resultaron inferiores a las de las intervenciones realizadas entre los 3-6 meses de vida, con el mismo tipo de cirugía. En coincidencia con estudios previos sobre la cicatrizacióny la remodelación de tejidos, los pacientes operados en período neonatal presentaron mejor alineación de sus segmentos maxilares y resultados cosméticos superiores. Ante la ausencia de complicaciones los niños fueron dados de alta el mismodía de la cirugía. La corrección quirúrgica temprana al acortar los plazos del tratamiento y requerir un menor número de operaciones, representa un sensible beneficio social y económico (AU)##á
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Fenda Labial/cirurgia , Fenda Labial/diagnóstico , Fenda Labial/terapia , Fissura Palatina/cirurgia , Fissura Palatina/diagnóstico , Fissura Palatina/terapia , ArgentinaRESUMO
El propósito del presente estudio fue evaluar los beneficios y las complicaciones que pudieran resultar de la reparación quirúrgica neonatal del labio y la nariz en pacientes portadores de fisura labio-alvéolo-palatina (FLAP) aislada. Con este fin, ingresaron a nuestro protocolo 22 recién nacidos con diferentes tipos de FLAP, los que fueron intervenidos con la técnica de Millard duranteel período Diciembre/93-Diciembre/94. Los neonatos toleraron perfectamente el procedimiento quirúrgico. Las pérdidas sanguíneas registradas resultaron inferiores a las de las intervenciones realizadas entre los 3-6 meses de vida, con el mismo tipo de cirugía. En coincidencia con estudios previos sobre la cicatrizacióny la remodelación de tejidos, los pacientes operados en período neonatal presentaron mejor alineación de sus segmentos maxilares y resultados cosméticos superiores. Ante la ausencia de complicaciones los niños fueron dados de alta el mismodía de la cirugía. La corrección quirúrgica temprana al acortar los plazos del tratamiento y requerir un menor número de operaciones, representa un sensible beneficio social y económico (AU)
Assuntos
Humanos , Masculino , Feminino , Recém-NascidoRESUMO
Mandibular reconstruction may prove to be a difficult problem. The use of vascularized bone flaps for mandibular reconstruction has shown better results than bone grafts because they offer solid bone union together with rapid recovery of form and function. The occipital vessels, from the external carotid artery and the jugular vein up to their site of emergence in the occipital fascia, have proved easy to dissect at the neck after section of sternocleidomastoid and splenius capitis longus and brevis muscles. We were able to obtain a long pedicle to move the fascia to distant sites with or without bone. Reconstruction was achieved with a full-thickness occipitoparietal bone flap, pedicled at the occipital vessels, released up to the external carotid artery to yield a long pedicle. We used this technique in four patients (age range, 8-14 years). We used vascular cranial bone for mandibular reconstruction. The cases included three resections for benign tumors (two fibromyxoma and relapsing aneurysmal bone cyst) and one hemifacial microsomia. No complications occurred. We describe some advantages with this procedure. A larger number of cases will allow us to draw further conclusions.